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Pharmaceutical inhibition of COX\u20102\u2013PGE2\u2013NF\u2010\u03baB signaling (COX\u20102, cyclooxygenase\u20102; PGE2, prostaglandin E2; NF\u2010\u03baB, nuclear factor \u03baB) has been shown in animal models to inhibit sIA formation and progression suggesting that use of medication inhibiting COX\u20102 could reduce intracranial aneurysm formation also in patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The impact of COX\u20102 inhibition on de novo sIA formation was studied in two cohorts: in a previously described angiographically followed cohort of 1419 sIA patients and in a cohort of 117 sIA patients treated with stenting or stent\u2010assisted embolization. Patients were identified from our population\u2010based Kuopio Intracranial Aneurysm Database. Data on the use of anti\u2010inflammatory medications and hospital diagnoses were obtained from national registries. Risk factors were identified by univariate and multivariate analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>De novo sIA patients were younger and more often smokers. Use of COX\u20102 selective inhibitors or nonsteroidal anti\u2010inflammatory drugs did not significantly reduce de novo sIA formation, but the percentage of patients with de novo sIA formation was smaller in patients with prescribed regular acetylsalicylic acid medication (1.1% vs. 3.6%). In the multivariate analysis, however, neither acetylsalicylic acid use nor other type of pharmaceutical inhibition of COX\u20102 reduced the formation of de novo sIAs. The risk was mostly affected by age, smoking history and irregular usage of antihypertensive medication regardless of used COX\u20102 inhibition level.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>For the prevention of de novo sIA formation, risk factor management with focus on cessation of smoking and treating hypertension adequately seems more important than pharmaceutical COX\u20102 inhibition.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.15442","type":"journal-article","created":{"date-parts":[[2022,6,9]],"date-time":"2022-06-09T14:11:36Z","timestamp":1654783896000},"page":"2734-2743","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Risk factor management matters more than pharmaceutical cyclooxygenase\u20102 inhibition in the prevention of de novo intracranial aneurysms"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0913-1491","authenticated-orcid":false,"given":"Sari","family":"R\u00e4is\u00e4nen","sequence":"first","affiliation":[{"name":"Neurosurgery of NeuroCenter, Kuopio University Hospital, and Neurosurgery, Institute of Clinical Medicine University of Eastern Finland  Kuopio Finland"},{"name":"Neurosurgery of NeuroCenter Kuopio University Hospital  Kuopio Finland"},{"name":"Hemorrhagic Brain Pathology Research Group, NeuroCenter Kuopio University Hospital  Kuopio Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jukka","family":"Huttunen","sequence":"additional","affiliation":[{"name":"Neurosurgery of NeuroCenter, Kuopio University Hospital, and Neurosurgery, Institute of Clinical Medicine University of Eastern Finland  Kuopio Finland"},{"name":"Neurosurgery of NeuroCenter Kuopio University Hospital  Kuopio 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